OT Role In Patients With Heart Failure

February 28, 2022Articles1

Congestive heart failure (CHF) is the most frequent diagnosis for hospital admissions and readmissions. 25% of patients with heart failure are readmitted in 30 days. Congestive heart failure affects people of all ages, from children and young adults to the middle-aged and the elderly.

Definition of Heart Failure

“Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body’s needs for blood and oxygen”. This results in fatigue and shortness of breath and some people have coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.

For an Occupational Therapist (OT), patients with heart failure are becoming a part of the everyday patient population in the acute care, sub-acute rehab, inpatient rehab, home health and outpatient settings. This is a population of patients that OT can greatly impact. OT’s role in treatment for patients with heart failure include:

• Occupation centered goals,
• Caregiver involvement,
• Facilitation of social participation, and
• Increasing a patient’s quality of life.

The occupational therapy framework outlines and guides an occupational therapist by providing the following information: client factors to consider, performance skills and patterns to address, activity and occupational demands, context and environmental factors that impact independence in occupations and types of interventions to maximize occupational outcomes.

Patients with Congestive Heart Failure (CHF) are typically on multiple medications when being discharged from the hospital. Most patients have multiple co-morbidities outside of CHF, which could be macular degeneration, dementia, and diabetes. These co-morbidities impact a patient’s vision, cognition and performance factors.

A Good Example

A 70-year-old female presents with CHF, diabetes, mild macular degeneration and beginning stages of dementia. She reported shortness of breath over a span of two weeks, fatigue and not being able to be as independent as she used to be. Her doctor admitted her to the hospital.

Health Management and Maintenance

Once admitted to the hospital, an Occupational Therapist performed an evaluation, with the history from her profile, and addressed her basic activities of daily living (ADLs). One instrumental activity of daily living (IADL) to address during this session is health management and maintenance with focus on medication routines to reduce her risk of readmission to the hospital. The OT educated the patient on use of a journal & pen to monitor medication intake. Due to her low vision, visual compensatory techniques were considered. She was educated on use of high/low contrast font on medication labels and increased font size to better read labels. The use of a medication pill box to separate medication by AM/PM and by day of the week were recommended to prevent her from forgetting her medication schedule and to prevent her from taking too many pills at a given time. Setting a phone alarm when medication time occurs was another technique discussed to maintain an accurate medication schedule. The OT discussed these techniques with patient’s daughter who was present to facilitate carryover of education.

Patient and her daughter were educated that hypertension can lead to heart failure and/or stroke. They were educated on importance of reporting symptoms to the doctor and taking medication as prescribed. Norma was also educated on monitoring edema in lower extremities to prevent risk of CHF exacerbation. If her shoes do not fit, this is a good indication to report this symptom to her doctor.

Patient was educated to monitor vital signs with use of blood pressure cuff and pulse oximeter. She can maintain a journal or ‘notes’ via typing or by voice command on phone to promote communication to doctor when going to doctor’s appointments.

Patient was also educated to program an “in case of emergency” contact in her phone and to keep her phone in the pocket of her clothing always. The Occupational Therapist educated the patient and her daughter on increasing font size on phone to better see phone numbers.

The OT also educated patient on environmental modifications and energy conservation techniques in the home to maximize independence and reduce fatigue leading to falls. Energy conservation techniques included:

• Placement of chairs throughout home to sit down,
• Taking rest breaks and conserving energy
• Performing IADLs seated instead of standing, i.e. sit during meal preparation
• Utilization of a four-wheeled walker during home establishment and management to transport a load of laundry from washer and dryer and to another room to sort and fold
• Use of a shower chair and hand held showerhead to conserve energy during bathing
• Placement of frequently used food and plates, bowls, cups in same location to avoid patient Walking back and forth, preventing risk of potential fall if patient becomes too fatigued

Summary

In summary, Occupational Therapists can have a profound impact on the independence and safety of this patient population. Gathering pertinent information from the occupational profile is vital to best serve these patients to meet their needs. OT intervention can decrease risk of further potential decline and injury to prevent risk of readmission to the hospital.